Dr. Stewart Ong, DPT

Details

Why Come to FYZICAL Therapy & Balance Centers?

Finding a medical provider to help you identify why your dizzy as well as treat the dizziness, as you know, can be challenging.  You often go from one provider to the next, never getting a definitive diagnosis and even worse very little assistance on treatment.

This will not happen at FYZICAL Therapy & Balance Centers.

In most cases, the cause of dizziness is associated with a disorder of the vestibular system - some say over 50% of cases. Common disorders of the vestibular system that can be diagnosed, treated, and managed at FYZICAL include:

·       BPPV Disorders (Anterior, Posterior, and Horizontal Canals)
 
·       Episodic Vertigo
 
·       Meniere's Disease (Medically Stabilized)
 
·       Migraine Associated Vertigo/Dizziness (MAV)
 
·       Vestibular Neuritis/Neuronitis
 
·       Vestibular Labyrinthitis
 
·       Fall Risk Seniors 
 
·       Vestibulopathies (Acute and Chronic)
 
·       Medically Stabilized Superior/Inferior Canal Dehiscence
 
·       Medically Stabilized Perilymphatic Fistulas
 
·       Medically Stabilized Post Acoustic Neuroma Surgery

·       Musculoskeletal Balance Disorders (MSBD)
 
·       Cervicogenic Dizziness (Spine-based Mechanical Dizziness)

When the vestibular system becomes malfunctioned, you develop dizziness symptoms.  There are several causes of dizziness.

·       Inner ear Dizziness – these are disorder that affect the actual sensor of the ear
·       Central Dizziness – these are disorders of the brainstem and brain.
·       Muscle/Joint (Mechanical) Dizziness – these are disorders of the joints and muscles often described as cervicogenic dizziness.
·       Sensory Mismatch Dizziness – this is a description of dizziness associated with the improper use of the three sensory systems for balance: vision, vestibular and sense of touch (somatosensory).

While there are many symptoms of dizziness, most describe these top five:

·       Vertigo
·       Lightheadedness/Wooziness
·       Visual Sensitivity/Motion Sickness
·       Unsteadiness/Dysequilbrium
·       Fear/Anxiety of dizziness

There are three primary forms of dizziness the physical therapists at FYZICAL treat:

·       BPPV – loose crystals in the inner ear
·       Sensory Mismatch associated with Peripheral and/or Central Vestibular Disorders
·       Sensory Mismatch associated with non-vestibular or mechanical disorders (Cervicogenic)
·       Combination of one or more of these forms

Benign Paroxysmal Positional Vertigo (BPPV)

If you have been through this site and across the internet, BPPV is the most common form of dizziness but often over diagnosed and misunderstood.  BPPV is diagnosed with a Dix-Hallpike and/or Supine Roll test to determine which canal or canals the loose debris is in.  The misunderstood part of BPPV is the word benign - it is not.  While the debris itself is loose calcium crystals, it is also parts of the sensor called the utricle that has sloughed off associated with an injury to it.  Once the utricle is injured, it is a permanent disorder and can lead to further BPPV events and slow, persistent imbalance.

If you have BPPV, all the clinicians at FYZICAL are trained in the most advanced treatments.  All the therapists at FYZICAL learn and can apply the following maneuvers:

·       Epley Maneuver
·       Quick Liberatory Maneuver for Horizontal Canal BPPV
·       Semont or Liberatory Maneuver
·       270 degree Barbeque Roll Maneuver for Horizontal Canal BPPV
·       Yacovino Maneuver
·       Casani Maneuver
·       Gans Maneuver
·       Gufoni Maneuver
·       Vannuchi-Asprealla Maneuvers (Long Sitting/Side Lying) and Variants for Horizontal Canal BPPV
·       Kim Maneuver

Every Level II and III Balance Retrainer at FYZICAL  gets over 36 hours of training in the assessment and management of BPPV along with ongoing mentoring and training from the FYZICAL Education department.

Moreover, if they cannot fix it, FYZICAL has four OMNIAX Chairs across the country to assist our clinicians when the BPPV is recalcitrant or difficult to remove.

·       Las Vegas, NV
·       Henderson, NV
·       Farmington Hills, MI
·       Ft Myers, FL

The Omniax chair was invented by Dr. John Epley, who was the pioneer in BPPV management.  The chair is designed to mimic the bedside maneuver using a gyroscopic chair to move you precisely in the proper positions to remove the calcium crystals from the canals.
Sensory Mismatch Disorders

The second type of dizziness physical therapy can treat is due to a phenomenon called Sensory Mismatch associated with a vestibular disorder.  Normally, when you are doing a task or moving in your environment, your brain naturally weighs the sensory inputs needed for the activity you are doing.  For instance, if you are standing still, you are primarily using your sense of touch - when you are moving you are primarily using your inner ears.  When you develop an injury to the inner ear (vestibular system), you brain must compensate with your eyes, sense of touch, and even your hearing to orient you. When it does this correctly, all is good.  But when the brain is incorrect, you feel dizziness.  For instance, when you are feeling unsteady on your feet what do you want to do...sit, of course.  What happens is because sitting feels so much better than standing or even walking, you start to sit more and more, finally developing a Sensory Mismatch.  Now, every time you get up and attempt to stand or walk, you feel even more unsteady and the dizziness symptoms feel worse.

Another example of Sensory Mismatch is with your eyes.  You vision is at its best when you are doing what...nothing.  Keeping your head still actually makes the visual system work at its best so often patients with dizziness will keep their heads still to increase the use of visual cues.  But again, what happens...you got it, you start to become visually dependent.  You may even start having neck pain and stiffness because you do not want to move your head.  The visual system can become so dependent that you develop a visual sensitivity and require sun glasses inside to reduce the glare.

The last type of dizziness the physical therapists treat is another form of Sensory Mismatch but not coming from the vestibular system specifically but from the joints and muscles of your body.  This is called cervicogenic dizziness.  Think about having injured neck, say in a whiplash event like a car accident or fall.  It often creates pain and limited motion, which can create symptoms of dizziness.  Physical therapists can resolve this pain and improve the range of motion in your spine to resolve the dizziness.

Why are we teaching you this...because when we looked at 822 patients retrospectively with computerized force plate testing using NASA-based technology, we identified everyone with dizziness develops Sensory Mismatch after a vestibular injury.  The key is not everyone is the same - some people are visually dependent, some are surface dependent, but most are both.  Some patients are more surface than vision and some are the opposite - vision greater than surface.

The key at FYZICAL Therapy & Balance Centers is we have the ability to identify these mismatches and treat them using our proprietary FYZICAL Balance Paradigm.

We know you hear this from so many providers - we have the answer, we are better...etc.

What we want you to know is at FYZICAL Therapy & Balance Centers balance assessing, understanding the symptoms, and treating dizziness is our passion - it is part of who we are, and it is in our name. What is even more important is at FYZICAL, there are 2,200 Medical Doctors, Physical Therapists, Nurse Practitioners, Physician Assistants, and Athletic Trainers working together to find the solution to your problem.

We are a family of experts working together under one brand to find the answer.  If you have recalcitrant dizziness and need help, please consider FYZICAL Therapy & Balance Centers.